天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (2): 119-123.doi: 10.11958/20192121

• 临床研究 • 上一篇    下一篇

血清Nesfatin-1和MMP-9对动脉瘤性蛛网膜 下腔出血预后的预测价值

曹兵 1，丁奇 2，刘春江 1，甄诚 1，刘熙鹏 1，张秀峰 1，王鹏飞   

  1. 1河北北方学院附属第一医院神经外科（邮编075000），2药学部
  • 收稿日期:2019-07-15 修回日期:2019-10-16 出版日期:2020-02-15 发布日期:2020-02-15
  • 通讯作者: 曹兵 E-mail:doctorwell88@163.com
  • 基金资助:
    河北省张家口市2019年度市级科技计划

The prognostic value of serum Nesfatin-1 and MMP-9 in aneurysmal subarachnoid hemorrhage

CAO Bing1，DING Qi2，LIU Chun-jiang1，ZHEN Cheng1，LIU Xi-peng1，ZHANG Xiu-feng1，WANG Peng-fei1   

  1. 1 Department of Neurosurgery, 2 Pharmacy Department, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
  • Received:2019-07-15 Revised:2019-10-16 Published:2020-02-15 Online:2020-02-15

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摘要： 摘要：目的 探讨动脉瘤性蛛网膜下腔出血（aSAH）患者血清摄食抑制因子-1（Nesfatin-1）和基质金属蛋白酶-9 （MMP-9）水平变化及与预后的关系。方法 165例动脉瘤性蛛网膜下腔出血患者作为病例组，根据90 d死亡情况分 为生存组（129例）和死亡组（36例）。研究对象采用酶联免疫吸附测定（ELISA）法检测Nesfatin-1和MMP-9水平，并 收集临床资料。通过受试者工作特征（ROC）曲线和曲线下面积（AUC）评价Nesfatin-1和MMP-9在aSAH患者预后 中的临床价值，应用Kaplan-Merier法绘制患者aSAH患者90 d生存曲线，采用多因素Logistic回归分析aSAH患者死 亡的影响因素。结果 死亡组血清Nesfatin-1和MMP-9水平高于生存组（P＜0.05）。血清Nesfatin-1和MMP-9预测 aSAH患者预后的曲线下面积分别为0.859（95%CI：0.796~0.908）、0.801（95%CI：0.731~0.859），临界值为9.98 μg/L和 402.21 μg/L时，敏感度分别为0.889、0.833；特异度分别为0.651、0.752。Kaplan-Meier生存曲线分析，Nesfatin-1≥9.98 μg/L和MMP-9≥402.21 μg/L时，aSAH患者90 d累积生存率较Nesfatin-1＜9.98 μg/L和MMP-9＜402.21 μg/L者显著 降低（P＜0.001）。Logistics回归分析显示，Nesfatin-1≥9.98 μg/L（OR=2.167，95%CI：1.776~2.642）、MMP-9≥402.21 μg/ L（OR=1.124，95%CI：1.029~1.227）、Hunt-Hess 分级Ⅳ~Ⅴ级（OR=2.246，95%CI：1.676~3.010）和 Fisher 分级 3~4 级 （OR=2.760，95%CI：1.369~5.565）是aSAH患者死亡的危险因素。结论 血清Nesfatin-1和MMP-9水平与aSAH患者 的预后密切相关，可作为预测aSAH患者预后的评价指标。

关键词: 动脉瘤, 蛛网膜下腔出血, 摄食抑制因子-1, 基质金属蛋白酶-9, 预后

Abstract: Abstract：Objective To investigate the changes of serum levels of Nesfatin-1 and matrix metalloproteinase-9 (MMP-9) in patients with aneurysmal subarachnoid hemorrhage (aSAH) and their relationship with prognosis. Methods A total of 165 patients with aSAH were selected as the case group. According to the 90-day mortality in the case group, they were divided into survival group (n=129) and death group (n=36). The levels of Nesfatin-1 and MMP-9 were measured and clinical data were collected. The clinical values of Nesfatin-1 and MMP-9 in the prognosis of aSAH patients were evaluated by ROC and AUC. Kaplan-Merier method was used to draw survival curve of aSAH patients, and the risk factors of death in aSAH patients were analyzed by multivariate Logistic regression. Results The serum levels of Nesfatin-1 and MMP-9 were significantly higher in death group than those of survival group (P＜0.05). The AUC curve areas of serum levels of Nesfatin- 1 and MMP-9 for predicting the prognosis of aSAH patients were 0.859 (95%CI：0.796-0.908) and 0.801 (95%CI：0.731- 0.859). When the critical values were 9.98 μg / L and 402.21 μg / L, the sensitivities were 0.889 and 0.833, and the specificities were 0.651 and 0.752 respectively. The Kaplan-Meier survival curve analysis showed that the 90-day cumulative survival rate was significantly lower in aSAH patients with Nesfatin-1≥9.98 μg/L and MMP-9≥402.21 μg/L than that of patients with Nesfatin-1＜9.98 μg / L and MMP-9＜402.21 μg / L (P＜0.001). Logistics regression analysis showed that Nesfatin-1≥9.98 μg/L (OR=2.167，95%CI：1.776-2.642), MMP-9≥402.21 μg/L (OR=1.124，95%CI：1.029- 1.227), Hunt-Hess grade Ⅳ-Ⅴ (OR=2.246，95%CI：1.676-3.010) and Fisher grade 3-4 (OR=2.760，95%CI：1.369-5.565) were risk factors for predicting mortality in patients with aSAH. Conclusion Serum levels of Nesfatin-1 and MMP-9 are closely related to the prognosis of aSAH, and could be used as an evaluation index to predict the prognosis of patients with aSAH.

Key words: aneurysmal, subarachnoid hemorrhage, ingestion inhibitor-1, matrix metalloproteinase-9, prognosis